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Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) study

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Abstract
The European Renal Best Practice (ERBP), which are issued by ERA EDTA, are suggestions for clinical practice in areas in which evidence is lacking or weak, together with position statements on recently published randomized controlled trials, or on existing guidelines and recommendations. In 2009, the Anaemia Working Group of ERBP published its first position statement about the haemoglobin target to aim for with erythropoietin-stimulating agents (ESA) and on issues that were not covered by K-DOQI in 2006-07. This second position paper of the group follows the publication of the Trial to Reduce Cardiovascular Events with Aranesp (R) Therapy (TREAT) Study. This multi-centre, placebo-controlled trial compared cardiovascular and renal outcomes in 4038 patients with type 2 diabetes, chronic kidney disease not on dialysis, and anaemia who were randomized to complete anaemia correction (haemoglobin target of 13 g/dL using darbepoetin alfa) or placebo (with a haemoglobin rescue value of 9 g/dL). Following the findings of the TREAT study, the Anaemia Working Group of ERBP maintains its view that 'Hb values of 11-12 g/dL should be generally sought in the CKD population without intentionally exceeding 13 g/dL' and that the doses of ESA therapy to achieve the target haemoglobin should also be considered. More caution is suggested when treating anaemia with ESA therapy in patients with type 2 diabetes not undergoing dialysis (and probably in diabetics at all CKD stages). In those with ischaemic heart disease or with a previous history of stroke, possible benefits should be weighed up against an increased risk of stroke recurrence, when deciding which Hb level to aim for. These recommendations are not intended to represent a new guideline as they are not the result of a systematic review of the evidence.
Keywords
PRACTICE GUIDELINES, IMPROVING GLOBAL OUTCOMES, EPOETIN-ALPHA, SECONDARY ANALYSIS, ANEMIA TREATMENT, MANAGEMENT, CHRONIC KIDNEY-DISEASE, stroke, erythropoiesis, chronic kidney disease, anemia, diabetes, stimulating agents

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Chicago
Locatelli, Francesco, Pedro Aljama, Bernard Canaud, Adrian Covic, Angel De Francisco, Iain C Macdougall, Andrzej Wiecek, and Raymond Vanholder. 2010. “Target Haemoglobin to Aim for with Erythropoiesis-stimulating Agents: a Position Statement by ERBP Following Publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) Study.” Nephrology Dialysis Transplantation 25 (9): 2846–2850.
APA
Locatelli, F., Aljama, P., Canaud, B., Covic, A., De Francisco, A., Macdougall, I. C., Wiecek, A., et al. (2010). Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) study. NEPHROLOGY DIALYSIS TRANSPLANTATION, 25(9), 2846–2850.
Vancouver
1.
Locatelli F, Aljama P, Canaud B, Covic A, De Francisco A, Macdougall IC, et al. Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) study. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2010;25(9):2846–50.
MLA
Locatelli, Francesco, Pedro Aljama, Bernard Canaud, et al. “Target Haemoglobin to Aim for with Erythropoiesis-stimulating Agents: a Position Statement by ERBP Following Publication of the Trial to Reduce Cardiovascular Events with Aranesp® Therapy (TREAT) Study.” NEPHROLOGY DIALYSIS TRANSPLANTATION 25.9 (2010): 2846–2850. Print.
@article{1068717,
  abstract     = {The European Renal Best Practice (ERBP), which are issued by ERA EDTA, are suggestions for clinical practice in areas in which evidence is lacking or weak, together with position statements on recently published randomized controlled trials, or on existing guidelines and recommendations. In 2009, the Anaemia Working Group of ERBP published its first position statement about the haemoglobin target to aim for with erythropoietin-stimulating agents (ESA) and on issues that were not covered by K-DOQI in 2006-07. This second position paper of the group follows the publication of the Trial to Reduce Cardiovascular Events with Aranesp (R) Therapy (TREAT) Study. This multi-centre, placebo-controlled trial compared cardiovascular and renal outcomes in 4038 patients with type 2 diabetes, chronic kidney disease not on dialysis, and anaemia who were randomized to complete anaemia correction (haemoglobin target of 13 g/dL using darbepoetin alfa) or placebo (with a haemoglobin rescue value of 9 g/dL).
Following the findings of the TREAT study, the Anaemia Working Group of ERBP maintains its view that 'Hb values of 11-12 g/dL should be generally sought in the CKD population without intentionally exceeding 13 g/dL' and that the doses of ESA therapy to achieve the target haemoglobin should also be considered. More caution is suggested when treating anaemia with ESA therapy in patients with type 2 diabetes not undergoing dialysis (and probably in diabetics at all CKD stages). In those with ischaemic heart disease or with a previous history of stroke, possible benefits should be weighed up against an increased risk of stroke recurrence, when deciding which Hb level to aim for. These recommendations are not intended to represent a new guideline as they are not the result of a systematic review of the evidence.},
  author       = {Locatelli, Francesco and Aljama, Pedro and Canaud, Bernard and Covic, Adrian and De Francisco, Angel and Macdougall, Iain C and Wiecek, Andrzej and Vanholder, Raymond},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {PRACTICE GUIDELINES,IMPROVING GLOBAL OUTCOMES,EPOETIN-ALPHA,SECONDARY ANALYSIS,ANEMIA TREATMENT,MANAGEMENT,CHRONIC KIDNEY-DISEASE,stroke,erythropoiesis,chronic kidney disease,anemia,diabetes,stimulating agents},
  language     = {eng},
  number       = {9},
  pages        = {2846--2850},
  title        = {Target haemoglobin to aim for with erythropoiesis-stimulating agents: a position statement by ERBP following publication of the Trial to Reduce Cardiovascular Events with Aranesp{\textregistered} Therapy (TREAT) study},
  url          = {http://dx.doi.org/10.1093/ndt/gfq336},
  volume       = {25},
  year         = {2010},
}

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